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Monday, August 20, 2012

MiM Mailbag: Should I stay or should I go?

For my entire life I knew I always wanted to be a doctor, that was never
a question. At the age of 5, I declared I wanted to be a pediatrician,
when the bossy know-it-all older sister of mine demanded I have a
career in mind. Since that time, I have had many experiences, working
in a veterinary, dental and "human" hospital setting and ultimately
chose medicine as my career. I was a straight-through kind of girl.
College, med-school, residency, boom, boom, boom. That being said, I
always had someone telling what, when, are where, that is, until 4th
year.

I finally had the chance to choose what I wanted, where, I wanted, etc
and I found it totally overwhelming. Before medical school, in college,
I spent a lot of time in OR's and doing clinical research. I was for
sure I was going to be a surgeon. Within the first month of medical
school, I had an OB shadowing experience and fell in love. Since that
point, I continued clinical research in OB and had a fascination with
the pathology, physiology, and academic side of OB. I did my surgical
rotation 3rd year and hated it- except peds surgery which I thought was
amazing. I then did OB, enjoyed the surgery part, but was less than
charmed by the OB lifestyle, attendings' attitudes, and inherent
"risks." I then did peds, loved the patients and parents, especially
low risk, "pleasant" growth and development outpatient issues, but truly
disliked inpatient and the "medicine" behind peds.

Then began the indecisiveness, peds ob peds ob, I weighed it back and
forth a million times, ultimately deciding I would miss the children in
my life too much not to do peds and regret the "lifestyle" of OBGYN and
malpractice of surgery and deliveries if I chose OB. I didn't even know
if I liked surgery, given that as a medical student we were lucky if we
even got to gown and scrub much less try our hand on the instruments.
Like many others, I was told, "If there is anything else you like, don't
pick this." So, there was something else I liked, and I didn't pick
OB. I thought, "How will this choice affect my future life and family?"

I am now an intern at a top program, I got my first choice, interviewed
everywhere I applied, and even got married and graduated medical school. With each "celebratory" experience I had this sinking feeling that I
had sold myself short. That I chose what I "thought" would be better.
Chose what would be a "rosier life" where everyone looked happy and ate
dinner with their children at night. But deep down as much as I tried
to convince myself that I was happy, I was never really "sold" on academic pediatrics. Do I love reading peds articles and
treatments? NO. Did I feel sad when I unsubscribed from the ACOG
listserve because it was like a slap in the face each month when I got
their mailings? YES.

So here I am, August of my intern year thinking, OH GOD, what did I do?
I did inpatient for a month, NOT a good fit. I am doing ER now and
like the pace, but cannot see myself in that ADD environment for my life,
and I only like the quick, "This is a cold you will be fine," not the
trached, g-tubed chronic kids because frankly, they break my heart. I
just cannot get the gusto to pick up a peds journal and read the stuff, I
have no interest in antibiotic choice for pneumonia, differentiating
between nephritic and nephrotic syndrome on a CMP or UA. I just don't
think I love pediatric medicine, but it makes me sad to think of
leaving the patients, happy attendings, and lifestyle behind.

My husband and I laid out a beautiful plan: work hard for a year or max 2
in residency then have a baby and finish in three quick years, BUY a
house and become real people with 2 real salaries and get rid of the med
school debt. I want this plan. I like this plan, the banker and the
happy, smiley little pediatrician wife. The only problem is, I am not
sure I can be that person, Looking toward the next 2.8 years of
residency looks like a long lonely road- 3+ months in a chronic care
facility, LOTS of months on the floor for heme onc, neurology, and
chronic GI patients. I want to like it, and there are some things I do
like, but I am not sure I can fall in love with the medicine, more with
the idea of it all.

I have felt a strong calling to switch to OB but every time I get close
to doing it, I back away and convince myself not to. But am I crazy to
leave peds at a top program for a specialty I am not sure is right?
It seems so shiny and exciting but is it? Will I feel better or think,
oh no, why did I leave peds? Is it work the risk? Should I just stick
it out, finish peds, then do a second residency if I really feel that I
need/want to? Is a second residency even a feasible option?

I don't like being the girl who cries all the time with a charmed life,
being tormented by the coulda shoulda woulda bug. But I don't want to
be the mom who wakes up in 10 years thinking "why did I switch?" or better
yet "why didn't I?" I don't want to be the ONLY unhappy pediatrician
anyone ever met because I was
wishing I was something else.

Now, in the midst of intern year, I am trying to sort out- do I hate
pediatric floor medicine and is that why I didn't like my first month? Was it just bad chemistry with my seniors and that made everyone
unhappy? Do I hate pediatric medicine but like the patients? Should I
give it
the old college try and stick out a whole year before I make a hasty
decision and switch because once I apply to switch, I am locked into
that and out of this?

What is hardest for me in making this decision as that I love the
children and the families. I love making them smile, laugh, and feel
well. I love reassuring the parents, and it breaks my heart thinking of
leaving them now. Truly breaks my heart. But academically it is just
not there for me. I want to be that person, but I am concerned that I
cannot get up enough interest to learn it all. Are most days in gen peds
outpatient clinic happy and well or are they chronic, and labs test
follow-up kind of stuff? Are the NP/s and PA's taking all of the
pleasant easy patients away?

I am scared to switch and the uncertainty it brings. What if I
don't like the OR? What if I have terrible hand eye coordination. What
if I am scared and don't actually like the OB setting? I have heard
that pediatric gynecology exists, but how many of these are sweet
chubby babies and how many irresponsible teens?

35 comments:

Go. If you're doubting it that much, and are that unhappy, it isn't worth it. I'm an ob resident and can't imagine doing anything else. What about doing ob as a family doc? You get the straight forward ob patient, don't have to do ORs, and get to take the new babies on as patients. Good luck with your choice.

Leave. Right now - don't wait out the year, try to find a program outside the much and go.I'm a PL-3 peds resident and I tell people all the time - it is not enough to find the kids cute and enjoyable. You have to love pediatric pathology. You will have to do at least 5 ICU months before you graduate by ACGME rules. You have to do at least one oncology and if the trach/GT kids in the ED freak you out, you will hate those months. Jess' suggestion of family med is a really good one. My husband is a PL-3 FM resident and he does primary care for straight forward kids, has the option to run a service where he can admit otherwise healthy kids with asthma, cellulitis, etc. and delivers babies. And it sounds like the right pace for the lifestyle you want. Luckily, a lot of FM programs (even my husband's super prestigious, ivy-associated program) accept people outside the match.

I agree with Fizzy. Whatever residency you ultimately complete, there will be periods of time that you don't enjoy, and they shouldn't deter you from a career path that is going to be right for you in the long run. I'm an internal medicine resident from Canada, and I hate ICU, but it's worth going through two miserable months of it in residency in order to end up in the career I want. (At least, that's what I tell myself. I may feel differently when I start ICU on Thursday.)

I've been through a tremendous amount of indecision about what subspecialty of internal medicine to go into, and in my experience major decisions like these can't be rushed. As unsettling as it is to not know what you're going to do with your life, my suggestion would be to sit with your decision for a while before making any major moves. You've been through less than two months of residency, which is hardly enough time to adapt to a new work situation/environment, let alone to really get comfortable with it. I'd at least wait until you're fully through that transition stage to make a decision about making a change. As well, I would suggest talking to as many people who are in the fields you're considering as possible. Talk to some practicing obs-gynes, pediatricians, and family physicians who focus their practice on obs-gyne/pediatrics to find out what the jobs are actually like and what things are good/bad about them.

It's not six months that she won't like - if she doesn't like the floors, and she doesn't like the ED, it will be six months she will absolutely hate, plus 9 months a year she won't like of floors and ED, every single year. And then, let me tell you, unless you are in the cushiest of all possible primary care practices, there is no getting to see only cute and healthy children - and if even picking out an antibiotic for pneumonia is painful, let me tell you, even the cute and healthy kids get pneumonia.

Nobody here can really tell you what's right for you. Specialty choice is such a hard decision. Personally, I left my residency in IM to do PM&R, and there are some days I know it was the right decision, and other days when I wish I knew what happened if I did something else.

It's only August and my impression is that you should wait a bit and see how you like future rotations. I think even if you didn't pick the wrong field, you may have picked the wrong program. If you hate really sick kids, you shouldn't have picked such an academic program. I'm sure there are tons of community programs where you would have done mostly outpatient.

As someone who has kids and has taken them to the pediatrician a LOT (especially this year), they are almost always seen by an MD, not an NP/PA. For well visits and mild sick visits. It's very possible (and probably most common) to have an outpatient pedi practice.

Maybe you should look into switching to a more outpatient-oriented pedi residency. Or possibly family med, as Jess suggested above. Of course, ob/gyn is an option, but I wonder how happy you'll be in it when you are filled with such uncertainty. Working your butt off is not a great thing to be doing when you're not sure if you even want to be doing that thing.

Go. But before you go, be clear on what you DO like -- I'm not clear at all on that from your letter.I'd agree with the suggestion of family med, though be warned that you'll also see a lot of hypertension and COPD, so it may not be a good fit either. From what you're saying, I doubt you'll like ped gyn either. If it's babies you like, you might try doing a rotation in the newborn nursery or even the NICU before you give up on pediatrics. I found that I liked OB but I gravitated to the baby more than the postpartum mom, which made me more a pediatrician than an OB-gyn. (Plus I hated gyn, but whatever.)Every single medical specialty has its bread and butter. That's what you have to really LOVE. Every specialty also has its problem diagnoses or problem patients -- those you merely have to be able to tolerate with relatively good grace and patience.

Hi I am the blogger who wrote the should I stay or should I go post and put this in the mailbag for some advice. I appreciate all the advice I have received and am not surprised that the replies vary as much as my own thoughts.

I thought about family medicine, but adult internal medicine is definitely not for me. Yes I would get uncomplicated OB and peds, but a lot of other "stuff" that I really don't care for. As for switching, some days I fly high thinking, "i'm gonna do it" then others I think "how can I leave after only one month?" True, I know you need to put your time in during residency doing things you don't like before you get to focus on what you do. The truth is, the stuff I love most is the bread and butter outpatient peds. I have liked every peds outpatient shadowing and working experience I have had. I like guiding the families, giving anticipatory advice, and reassuring, "this will be fine." I do not like ICU, chronic care, etc party because it seems overwhelming, partly because it seems boring to be, and partly because so much of it is just so sad.

When I think about switching, it is a temporary high, and then its like I fall right back down to earth and think, I don't know that I want to be a general OBGYN- delivering babies seems like scary stuff to do forever. There is no gurantee to get a fellowship nor a gurrantee that I will be happier doing some dimension of OB and leaving peds. I was ambiguous about surgery, but now that I am NOT doing it I wonder if I should have. I Feel like I am in some way missing out. Then again, not ready to throw away the smiles and giggles even when I shimmy right up to the edge to jump.

I even think, well maybe pediatric and adolescent gyne would be cool, but you miss the developmental stuff, family relationships, but get the academic and intellectual curiosity dimension filled in.

I just don't know. I am a nurturer at heart, always wanting to "make people feel better" that is why I chose to be a doctor. Now I find myself confused as to where I want to focus that energy and if life beyond residency will be what I hoped, or if I will feel like a big fake for the next 3 years as I do now and beyond. I and not sure how much longer I can "feel it out" without missing my window, but then again I am not sure I want this window to close forever either.

When I went to meet with a member of the OB department to discuss this, I felt like I was flying, ready to jump but now, am back in my cocoon and scared to leave the nest.

It has been so many years in the making- school and more school- and now I feel lost and unfulfilled trying to do one thing all the while secretly watching the others and seeing what I missed albeit trying not to look.

Every day I wake up hoping I'll "just know" it hasn't happened yet and maybe never will. In the mean time, I would just like to feel like myself again, happy, normal and fulfilled. Finally feel like its ok to get pregnant, start my family, and adult life.should I stay or should I go?

This is so similar to my situation.. after picking dental school.. now I'm between pediatric and Maxillofacial surgery. I like parts of both and I hate parts of both. I know my life will be great in pedo. I will have a fun practice.. I know I'm great with kids.. I know I want to go into Pediatric but it hurts everytime I see a surgeon. EVERY.SINGLE.TIME. So that is how I made the decision.. I already know I'm going to regret it but I'm atleast going to give surgery a shot. I cannot live with the regret if I didn't even try. Good luck with ur choice. Its going to be regret bothways.. so why not pick the one you will miss more?

I really dont think your experience is all that uncommon. First of all, the vast majority of interns question their decision during the 1st year. Whether the question their program, specialty, or medicine totally. Truth is I hated atleast 80% of my residency experience - but love fellowship. You owe it to yourself to complete your first year before you make any decisions. Second, as the year progresses, remind yourself that "work should feel like play", as my father used to say. You are going to be spending the next 30 years practicing medicine. If you dont select something you are truly passionate about you will be miserable. And when you are miserable at work, you will ultimately bring that home, and the whole family will become miserable. Third, it is not as hard to change residencies or specialities as one might think. If your program allows interns to do electives, try an elective in Peds Gyn.....it may help answer your question for you. I am married to a surgeon, and I have a surgeon mentality, and I love procedures. But we wanted a family, and I was able to find something that allowed me to use my technical skill, while still enjoying a family, and flexible hours. I do Peds EM, I cant imagine ever doing anything else, we are happy and have wonderful kids, and have an amazing lifestyle. This worked for me. BUT you need to do some soul searching AND figure out what will work for YOU. Good luck :)

I am a sub-specialist pediatrician who loved looooved, but late in the MSIV game, made a decision to change to pediatrics (that’s a different story). Not 3 days ago, I was chatting with 2 surgeon colleauges, & made a comment about what might have been. Both immediately said “If could have found it, I would have done something else…my ‘life’ sucks...but I just love surgery.” No question, I work long difficulty weeks/weekends and have to sacrifice time from my family for my practice, but without a doubt, the life of a good surgical specialist demands far more. If you are willing to test the waters of the strain that being an OB/Gyn will put on your personal life, and you can be sure that you can’t be happy as a pediatrician, than go for it.

For anyone in your predicament, try to remember, there should be nothing easy about medical education training, regardless of your chosen specialty. The ACGME has standard credentialing requirements for very serious reasons. Being able to recognize the early stages of disease, preventing a further spiral can absolutely be life saving to a patient. And think about the impact you could have on so many patients & their families if you could prevent them from ever having to see the uglier sides of disease. You cannot begin to gain that experience without learning vigorously during residency training. There are rotations we all must suffer through, but there is always light at the end of that tunnel, be it the module or the program. Whether you decide peds or OB/Gyn, or for anyone choosing a career, your training program should be rigorous & demanding if you want/expect to be an excellent physician. The rewards of a nice lifestyle come later.

As someone who continually questions my career within medicine I understand and empathize with your struggles. Before you switch I would consider perhaps a pediatric subspecialty--perhaps pediatric cardiology. It's a demanding field but you have a good relationship with families and have a positive impact on the children. It may be worth asking your PD if you can do an elective in a subspecialty that you think may excite you. Just because you dont like general pediatrics doesn't neccessarily mean that the field may not have other opportunities for you.

I also want to add that as a person who did switch residencies, this is not a choice you need to make immediately. I didn't make the decision to switch until December and still found a spot for the next year. Take your time to investigate the situation thoroughly and maybe speak to some pediatricians in outpatient practice. I'm sure you know that you are likely going to face a huge amount of resistance if you attempt to break your residency contract and leave before the end of the year, so I think either way, you should resign yourself to finishing your intern year in peds, and then you'll have to repeat your intern year if you switch to ob/gyn.

Try thinking about what are you drawn to, not repelled by. I feel for your predicament, and you sound like someone who cares for and about people and families.

I'm a general outpatient (primary care) pediatrician for underserved kids, also heavily involved in medical education. I love much of what you wrote about, the helping children grow and develop, maximizing health even in difficult social situations. So I want to say STAY IN PEDS, but reading what you wrote, I'm a little worried about you staying in a field you will always feel saddened by, or left feeling like you should have done something else. I'll note that I also LOVE my pediatric journals (and caring for babies, kids, and teens.)

Internship in any field is difficult. Maybe as the straight through gal, you can instead take some time away/off/other for a little while. Being away might tell you what it is that you want to go back to (or switch into).

I will chime in here and tell my story:I was a MS3 in my 3rd rotation when I fell in love with Peds. I really had no clue what I wanted to do, but I totally dug all the kids, the pathology was neat, it was awesome. Then I did my 4th rotation - OB/Gyn. And I fell harder. It was obvious peds had to go as my top choice. I loved OB because it was surgery AND clinic, helping women, delivering babies. And narrow pathology - become a specialist in one area of the body. What's not to like?

Then I scrambled. I thought I might go for a Peds spot, because, Hey! 2nd choice. But there were very few available. I ended up with an FP spot at a small community program. I was slightly hesitant because I felt like you did - unexcited about COPD/HTN/DM...ugh. So exhausting. The only slight excitement I felt before I started was OB. I would still get to deliver.

I spent my intern year delivering babies and learning ALLLLLL the crap ton of general medicine I clearly didn't know. In our program, you don't usually do OB past the first year, so I did it up. And I loved every minute. It was amazing. But then I finished first year. And I had one or two straggler OBs, but basically, I was done. And I didn't miss it anymore. I didn't crave it. I also did tons tons tons of general peds. And I loved it. Still absolutely love it as the bright point of any day. But no true pathology - which is great because my brain only holds so much. I had my son in the middle of my PGY2, and I really got over OB. Because I wanted to be home, not delivering babies in the middle of the night. And I still loved kids (Which I thought would change when I had one), but it was different. And the best part was that I really grew to love treating the adults, for so many reasons. Yes, I mostly still internally roll my eyes at COPD/HTN/DM. They are chronic and dull some days, and a complete PITA to get controlled. But it's still a joy to do, as I'm fairly sure EVERY medical specialty is on SOME day.

So, this is not really a plug for FP, but more a comment that, with time/life changes, you often change what you really want. I think others above me have said as much. That's not to say don't switch. Just be sure you factor in some other things (that I totally wouldn't have thought of had I not stumbled into my dream career). It's hard. It's hard to change, I can't even imagine doing it without being forced to. I wish you the best of luck!

What wonderful advice you've been given! For my 2 cents worth - I'm an Australian Obgyn trainee with 3 years left to complete the program. I'm currently cuddling a 3 month old who smells divine, trying to figure out how I'm going to make it all work. What I know is that I adore my family & I love my work, so everything will be fine. If I was more ambivalent about work, I think it would be infinitely more difficult. It sounds like you're a passionate person - find a career you're interested in. I think the rest will follow.

Someone advised me that you're trying to decide between two 'right' specialties, not a right and a wrong one. It helped ease my mind that there are ups and downs of every specialty and more than one way to be mostly happy with work.

I switched out of OB. The lifestyle is pretty rough and I think you may be romanticizing it. Before you switch at least do yourself the favor of talking to some private ob attendings and DEFINATELY shadow some in private practice while they are taking the really long calls. I have the indecision bug too, I understand. But I loved the OR which made it harder to leave OB and even I switched out. The people I know who are happy with OB are the die-hard, this is #1 priority and I-can't-fathom-doing-anything-else type people. It takes that type of dedication and grit to do it bc it is SO demanding and stressful. I thought I would love it and I actually did love my intern year of OB, and even with that, I switched out bc I felt I was really missing out and would continue to miss out on my child's life. I think if you could imagine being happy in outpatient peds, stick it out. If you like well baby checks, 3 years from now you are going to be another happy pediatrician, and don't kid yourself! that is awesome. It is just as respected and cool as Ob. Moms will love you. You will see when you have your own baby. Having a good pediatrician is such a huge deal. I would get on an antidepressant too. I think some of it may be intern blues/depression. Hope you work it out and best of luck to you.

As a CPNP, I take offense to your comment regarding NP's/PA's taking away the "easy" patients. I manage very complex kids and, quite honestly, run circles around the interns I work with. However, they are smart enough to realize that I have 17 years of pediatric experience, and can teach them a whole lot. Do yourself a favor and embrace your NP's as part of the team...most of us have a lot to offer.

Neither younpr your residency wants you to be there of you are not pleased w your choice. And you won't be the first to have your doubts or switch.

Sit down w your program director and let her/him know what is going on. Can u take time off residency to do a solid month or two of OBGYN shadowing? If you stayed in Peds after that, you'd only end up a few weeks behind, and that would be time well spent making a decision. If you switch to OB, you know what you are getting into AND have your foot in the door at the program at which u shadowed.

I'm a veterinarian, not a physician, but I recently changed my practice specialty (not as easy as those who are not veterinarians who have done this might think!) Why? After a number of years of career success while trying to convince myself I liked what I was doing, the James Herriot Dream, I finally had to admit I really didn't like it to the point it was making me and those around me miserable. I COULD do it - just as I have no doubt you could be successful in whatever specialty you select - but I didn't WANT to do it.

First, I had to mourn the death of my identity. Eventually, I realized all the pressure I felt to prove myself in my original, highly demanding specialty came from me. Yes, I could have stuck it out until retirement, only a few short decades away. But why?

My closest friend still works in my original specialty and teases that she wants to hire me per diem during her vacations because I'm exactly the colleague she'd trust with her clients. It's just a joke, though, because I've managed to find something I really like to do, and she knows it. The highs aren't as high, but the lows aren't as low, and the lows were the problem. I can get my highs from achievements in my private life.

My SO is relieved I don't come home sad or angry anymore.

Judge your chosen specialty by the worst days, not the best. You may love delivering healthy, cute, planned babies whose mothers are healthy with uncomplicated births, but I'm guessing patients with chronic pelvic pain, unintended pregnancies and infertility will wear you down, and don't forget the bad births and miscarriages. In outpatient peds, you'll see mostly healthy patients with routine complaints and develop relationships with families. Occasionally, you'll see a kid with something devastating like leukemia or CF, or one of your adolescents may become pregnant or contract an STD. It doesn't sound like a bad life, if you like that sort of thing (I don't!), which is why you have to decide for yourself. :-)

I think it's important to remember there can be multiple "right" choices as far as your career goes. What is it about OB that you miss? Procedures? Then how about a procedural Pediatrics specialty? You have to be ok with the bread and butter work of whatever you do. What is it that gets you up in the morning? What do you find meaningful? How important is a controllable lifestyle to you?

Wow, so many good and helpful people have weighted in on my debate. I cannot thank you enough for your support and advice. It is quite true that there are many right choices and I think that is the problem- you cannot have it ALL. You have to pick one and move on and that has been the problem. There are days when I go to work and the days seems endless, others when it flies by. The only reason I like "pleasant peds" is because I don't like complicated peds. That being said, infertility, misacarriages, pelvic pain- none of that scares me. Working with women empowers me. That is partially why I picked peds for thw children's smiles and the filling of the mom's with confidence, you can do this, and "we will get through this" talks. There are so many days I wake up thinking, if I wasn't married, tied to someone else, worrying that pursuing my dreams may ruin my marriage, delay my life, I think, it would have been no question, I would have gone into OB and done reproductive endocrinology. What I for so long found fascinating. There are just so many roadblocks- competitive fellowships, moving from city to city. When your life is tied to someone else's how can you just say, 3 years is up, lets move on. Needless to say, my husband says everyday, DO WHAT MAKES YOU HAPPY, I will support you 100% either way. I know this is true, I just hate dragging him through the mud with me, and let me tell you, this year has been muddy.

I think I am constantly beating myself up and looking back because I have been trying to fit into this mold I think I should fit into and truly want to fit into. Yes, I love children and talking to families, but intellectually, none of that tickles my fancy.Talking to women about gynecologic conditions, reading, studying, teaching about that pathology interests me. All my research in medical school was gyne- why? because it was interesting to me. as simple as that. I love endocrinology and the hormonal axes, but, SIADH and DI, not so much, LH FSH and hyperprolactinemia, bring it on.

Yes, I was afraid that I didn't love surgery enough and being out of the OR its hard to say if I miss it- but how would I know, I have never "done it."

I only have one life, that is why this has been so hard, because I don't want to screw it up, but at the same time, I don't want to live the next 50 years thinking "I am doing the wrong thing." What I just have to accept is that there is no perfect answer, and you can never have the cake and eat it too. You just have to find what lights your fire. Someone said, "work should be like play" and at this moment, yes, I do get to "play" with the kids, but then I have to listen to their little lungs and think " I have no idea if you are ok enough to go home" and yes, I want to snuggle the little peanut and take in her heavenly little scent, but sometimes, its the little one I want to cuddle and not the medicine I want to talk about.So again, I will miss the little faces if I leave, as those are priceless and fill my heart with joy and day with light, but I know deep down I do not love the academic part, what I am supposed to be looking for and why.I think it is time I just take a leap but like before I feel paralyzed, waiting for the lighting to strike and me to "finally know."

To clarify, I think I have to decide if my "academic" interest is more important, since I have come this far- I should train to do something I love, or is my "life"/"style more important? The life I "think" I want.

DocInLimbo- I wish I had found this blog earlier. You sound 100% like me. I am currently in my intern year at my first choice peds program and have been debating about switching to Ob/Gyn too. Your thoughts, the debate in your head, the back and forth that you describe, I am the exact same way! I even spoke with my PD about this, and we decided I would stick it out a bit and if half-way through this year I still feel the same, then I'd have to start looking elsewhere. And while most days at work I am unhappy and constantly thinking about OB, I cannot and have not taken the plunge and re-entered the match and it annoys me that I haven't just figured it out by now! So it's been a few months since your last post, but I have to know (to help me as well) what did you decide? Reading your post put a smile on my face because it sounded like my own words on paper...

malibuRN, I am still in my peds program . . . mostly happy but honestly jealous of anyone doing anything surgical... and still having second thoughts a lot of the time. I do love children, but I still don't think general pediatrics is 100% the right fit for me. Nor have I found any fellowships that make my heart sing. I think the best thing for me is to do a second residency in OBGYN . . . that way I will have the best of both worlds and a million options open. I need the OR and realize that as much as I thought I could live without it, I miss it, dearly. Much as I miss the comraderie of surgery-type people. I would love to talk to you in a private message but am not sure how to do this. what did you decide? and did match day make you so sad this past week too?

Hey DocInLimbo!This is MalibuRu, it was nice to hear back from you! It still makes me laugh when I read your posts and I think about how you take the words out of my mouth each time...So I initially contacted the program coordinator at the hospital I did my ob/gyn rotation and she put me in touch with the program director of the residency there (before residency applications I had rotated at this hospital that tried to recruit me heavily, not knowing I was also thinking of peds at the time). He told me to reapply and they'd interview me and that he was suprised when he heard I went into pediatrics...I started to think of reapplying as well, began to rewrite a PS, spoke with my PD (did not tell PD that I wanted OBGYN but only that I was considering making a switch b/c i did not feel connected to residency so far). And then I froze too. I thought maybe I would begin to love it and see why I am so unable to move, and for a short while I started to look into ED fellowships in peds and have started to rekindle my love for global health, and now I am back to where i started- not loving my day to day at all and always thinking about and yearning for OBGYN. I cannot figure out why I can't make the switch and what is holding me back, but at the same time i feel like I am wasting time. Why would I do a second year of residency only to decide to switch still? I worry about the lifestyle also since that was a big reason I ultimately chose peds. But everytime I get a female adolescent patient wanting to talk about OCPs, I get excited, I love talking to moms with newborns about all the anticipatory guidance, I love talking to moms coming in to the hospital in premature labor while I'm on my NICU rotation...you would think that these things I get excited about would tell me without a shadow of a doubt that I should switch. I have co-residents tell me all the time how they could see me as an OBGYN which doesnt help me at all! I know I am indecisive and fearful by nature, but that should not hold me back. And then I worry what if I switch and I dont love that either? Although a year later I am still thinking about ObGyn and envious of those that have chosen to go into it. I miss using my hands and doing procedures, I get so tired of rounding and talking and rounding and talking. Now I am just rambling, but I know exactly how you feel. I go back and forth all the time in my head and get annoyed when I begin to wonder why I didn't think this through more prior to residency applications. I start my second year with PICU and if I don't love that then I think I have to make the change...I have yet to be truly excited in residency. I love kids and I have made some great friends, but I just don't love the day to day and am coming to realize I am not as interested in the medicine behind all of this either...

maliburu- are you still out there? its DocInLimbo,I am in third year now, planning to apply for neonatology as that seems the most appropriate next step and i like it, when im doing it, but I still feel pangs of physical sadness and jealousy when i see the ob residents buzzing around l and d. I have contacted some ob programs, even tried to arrange an away rotation during my IS month but chickened out ultimately. oh and did I mention i had a baby? throw that into the equation. i wish i could PM you but don't know how to find you!what did you do?

Wish my book was published (getting there) as a practical tool for you (it's a 6 step decision making method with an organic/non-systematic feel--i.e.: I hate formulas), but maybe my blog, along with a shortened version of my steps (found on left sidebar) might help: www.chickswithchoices.com. Mostly, listen to your own inclinations, not another voice (which can come in may forms like "tradition"--this is what my family would do). So often we make decisions based on what others want or a fear of rejection. A lot to it, but that's just a quick thought. Hope you stop by...

Hi there: This is docinlimbo. Given that it was match day this past week, I wanted to revisit this post as my indecision was creeping back into the picture. Although things have gotten much better, I talked to a counselor, and even my PD . . unfortunately, I am still in limbo . . . after this post, I created my application, talked to my PD, and cried every day . . . all I had to do was click submit . . . but again, I just couldn't do it... for the second time in a row. I basically came to the decision, that there had to be a reason that I didn't leave peds in the first place. So after thinking about it . . .over and over . . .I decided that since peds was so short, only 3 years, it made sense to complete the entire residency and then decide what I wanted to pursue next. With each passing day, I realize how much I miss the OR and doing procedures. Thus, I think I will just do a second residency in OBGYN when I am done. I have also thought more recently about pediatric surg but think that if I ever want to have babies, that the boat for 10 more years of training may have sailed . . . either way, I am generally happier and relatively settled but feel panic at having to decide my next step as soon as this fall . . .fellowship in peds vs second residency vs graduate and get a job . . . the decisions are endless, but for now, I am working, learning, and taking care of babies . . . what could be better than that?

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